| NPI | 1194672576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 101Y00000X Counselor (Licence: NE 14761) |
| Additional Taxonomies | 1041C0700X Social Worker, Clinical (Licence: NE 8326) |
| Enumeration Date | 2026-03-13 |
| Last Update Date | 2026-03-13 |